肺结节交互印证式诊断准确性及可行性研究：1368例报告

目的通过肺结节交互印证式诊断,提高术前影像诊断的准确率,选择合适的手术时机,指导肺小结节的随访时间。方法回顾性分析单中心2016年7月至2019年10月厦门大学附属第一医院胸外科1 368例肺结节手术患者的临床资料,男531例、女837例,年龄44(21～67)岁。选择肺结节直径≤2 cm,术前行多学科会诊,详细阅读胸部CT,术中切开病灶剖面进行分析,快速病理诊断肺结节性质,术后常规行病理诊断。随后将肺结节影像特征、术中剖面特征与病理结果一一对照,通过两两对应,交互印证,把肺结节的影像病理及病变切面表现为一个动态变化的过程。结果在1 368例肺小结节患者中,影像学表现为纯磨玻璃样结节的有376例(27.5%),混合性磨玻璃样结节共有729例(53.3%),实性结节共有263例(19.2%)。在纯磨玻璃样结节患者中,原位腺癌(adenocarcinoma in situ,AIS)占比最高,为156例,微浸润性腺癌(microinvasive adenocarcinoma,MIA)和不典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)比例相当,分别为90例和85例,其它良性肿瘤共20例。在混合性磨玻璃样结节中,浸润性腺癌(invasive adenocarcinoma,IA)共495例,其次是MIA 207例;且在实性结节中,病理结果主要为IA和其它良性肿瘤,分别为213例和50例,实性结节病理无AAH、AIS及MIA。结论肺结节交互印证式诊断可以提高术前诊断的准确率,对选择手术时机、随访时间的判断具有重要意义。     

肺原位腺癌和微浸润腺癌489例的临床病理与预后分析CSCD

目的探讨肺癌中原位腺癌(AIS)与微浸润腺癌(MIA)的临床病理特征及其治疗策略。方法回顾性分析我院2007年1月至2015年8月489例AIS和MIA患者的临床资料,其中男122例、女367例,平均年龄26~78(51±9)岁。根据病理类型,分为AIS组(246例)和MIA组(243例),其中AIS组男60例、女186例,平均年龄(50±7)岁;MIA组男62例、女181例,平均年龄(54±5)岁。对比两组患者临床病理特征、手术方式及预后。结果 AIS与MIA患者在年龄、癌胚抗原(CEA)指标、结节形态、结节大小上差异均有统计学意义(P<0.05)。AIS患者大多为60岁以下的患者,肿瘤标志物中CEA指标一般在正常范围,且CT上常表现为直径1 cm以内的纯磨玻璃结节,而MIA的CT表现常为直径小于1.5 cm的混合磨玻璃结节,更常伴有支气管扩张和胸膜凹陷征。AIS组及MIA组的5年无瘤生存率均达到100%,并且亚肺叶切除(包括肺段切除及楔形切除)与肺叶切除、系统性淋巴结清扫与纵隔淋巴结采样对患者的预后差异并无统计学意义。结论术前临床及影像学特征分析可以对AIS及MIA这两种组织学亚型进行预判,从而为患者个体化手术及术后治疗方案的制定提供帮助。     

CT影像组学联合CT特征预测肺亚实性结节侵袭性

目的 观察CT影像组学联合CT特征预测肺亚实性结节侵袭性的价值。方法 回顾性分析170例肺亚实性结节患者资料,包括6例非典型腺瘤样增生(AAH)、12例原位腺癌(AIS)、58例微浸润性腺癌(MIA)及94例浸润性腺癌(IAC),将AAH、AIS和MIA归为非侵袭组、IAC归为侵袭组。按7∶3比例将患者分为训练集(n=119,含5例AAH、9例AIS、36例MIA及69例IAC)和验证集(n=51,含1例AAH、3例AIS、22例MIA及25例IAC)。采用单因素及logistic回归分析训练集患者一般资料及病灶CT表现,筛选预测肺亚实性结节侵袭性的独立危险因素并建立CT模型;基于训练集提取及筛选病灶最佳影像组学特征,以之构建影像组学模型。基于CT模型及影像组学模型构建联合模型,并以列线图将其可视化。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),基于验证集评估各模型诊断效能;以校准曲线评价联合模型的校准程度。结果 CT所示结节长径和最大CT值为预测肺亚实性结节为IAC的CT相关独立危险因素,以之构建CT模型。基于训练集筛选出6个最佳影像组学特征并构建影像组学模型。CT模型、影像组学模型及联合模型预测验证集肺亚实性结节侵袭性的AUC分别为0.772、0.785及0.869;联合模型的AUC高于CT模型(Z=2.336,P=0.019)而与影像组学模型差异无统计学意义(Z=1.925,P=0.054),其预测结果与实际结果的一致性较高。结论 CT影像组学联合CT特征可有效预测肺亚实性结节侵袭性。     

肺原位腺癌和微浸润腺癌489例的临床病理与预后分析

目的探讨肺癌中原位腺癌(AIS)与微浸润腺癌(MIA)的临床病理特征及其治疗策略。方法回顾性分析我院2007年1月至2015年8月489例AIS和MIA患者的临床资料,其中男122例、女367例,平均年龄26~78(51±9)岁。根据病理类型,分为AIS组(246例)和MIA组(243例),其中AIS组男60例、女186例,平均年龄(50±7)岁;MIA组男62例、女181例,平均年龄(54±5)岁。对比两组患者临床病理特征、手术方式及预后。结果 AIS与MIA患者在年龄、癌胚抗原(CEA)指标、结节形态、结节大小上差异均有统计学意义(P0.05)。AIS患者大多为60岁以下的患者,肿瘤标志物中CEA指标一般在正常范围,且CT上常表现为直径1 cm以内的纯磨玻璃结节,而MIA的CT表现常为直径小于1.5 cm的混合磨玻璃结节,更常伴有支气管扩张和胸膜凹陷征。AIS组及MIA组的5年无瘤生存率均达到100%,并且亚肺叶切除(包括肺段切除及楔形切除)与肺叶切除、系统性淋巴结清扫与纵隔淋巴结采样对患者的预后差异并无统计学意义。结论术前临床及影像学特征分析可以对AIS及MIA这两种组织学亚型进行预判,从而为患者个体化手术及术后治疗方案的制定提供帮助。     

1263例肺部结节术中冰冻病理诊断分析

目的 探讨肺部结节术中冰冻切片诊断的要点及难点。方法 收集首都医科大学附属北京朝阳医院2021年1月—2022年1月肺部结节病例的术中冰冻及术后石蜡病理诊断结果,以术后石蜡诊断为最终诊断,分析冰冻诊断中误诊病例的主要原因,总结容易误诊病例的诊断及鉴别诊断要点。结果 共纳入1 178例患者的1 263例冰冻病理结果,其中男475例、女703例,平均年龄58.7(23～86)岁。1 263例冰冻切片的病理诊断正确率为95.65%,误诊率为4.35%。误诊病例55例,分别为浸润性腺癌18例（3.44%）、原位腺癌17例（5.82%）、黏液腺癌7例（35.00%）、微浸润性腺癌4例（2.09%）、IgG4相关性疾病3例（100.00%）、黏液型原位腺癌2例（66.67%）、非典型腺瘤样增生1例（16.67%）、硬化性肺细胞瘤1例（14.29%）、细支气管腺瘤1例（33.33%）、乳头状腺瘤1例（100.00%）。结论 术中冰冻诊断仍具有其局限性,临床医生需结合影像学检查及临床经验综合判断。     

薄层CT表现为磨玻璃结节的浸润与微浸润性肺腺癌的影像与病理的对照研究

目的通过CT影像学为肺部磨玻璃结节与其术后病理确诊为微浸润腺癌(MIA)和浸润性腺癌(IAC)的对照, 研究肺部CT磨玻璃结节对于术前诊断和鉴别诊断肺部MIA和IAC提供帮助的可能。方法对福州肺科医院2018年3月至2020年3月收治的200例肺部磨玻璃结节患者的CT图像进行回顾性分析, 对病理诊断分为MIA组(109例)和IAC组( 91例)两组病灶的大小, 病灶密度、形状、边缘毛刺、边缘分叶, 结节病灶内实性成分, 实性成分大小, 分布, 边缘、内部空泡/空腔, 支气管截断征, 病灶内血管影, 病灶内血管增粗, 病灶内血管扭曲或模糊, 胸膜凹陷征, 血管集束征进行对比分析。采用chi-square检验。结果 MIA影像多表现为纯磨玻璃影, 圆形或类圆形, 边界较清晰;IAC多为混合密度的磨玻璃结节, 不规则形多见。边缘分叶的结节中是IAC比例比MIA比例高(96.1%比3.9%, χ2=42.146, P<0.01);边缘毛刺的结节是IAC的比例比MIA比例高(95.0%比5.0%, χ2=15.895, P<0.01);有实性成分的结节中IAC比例比MIA比例高(71...     

循环肿瘤细胞联合低剂量螺旋CT对恶性孤立性肺结节病理浸润的预测价值

目的探讨循环肿瘤细胞(CTC)联合低剂量螺旋CT(LDCT)对恶性孤立性肺结节(MSPN)病理浸润的预测价值。方法2018年7月至2019年5月于福建省立医院胸外科连续收治120例LDCT检出的孤立性肺结节(SPN)患者。术前检测CTC、测量LDCT上肺结节实性成分占比(Cdmax/Td),以术后病理为诊断金标准,采用受试者工作特征(ROC)曲线评估CTC、CTC联合LDCT对MSPN病理浸润的预测价值,并采用χ²检验或Fisher精确概率法分析CTC与MSPN患者临床特征的相关性。结果120例SPN中,恶性肺结节102例(85%),其中肺腺癌97例(81%);含浸润成分的MSPN[包括微浸润性腺癌(MIA)、浸润性腺癌(IAC)]CTC明显高于不含浸润成分的MSPN[原位腺癌(AIS)][10.65(9.05~12.70)比8.00(6.85~10.20)FU/3 ml,Z=-3.119,P<0.05];CTC、Cdmax/Td预测MSPN是否含浸润成分的曲线下面积(AUC)分别为0.770、0.855;CTC联合Cdmax/Td预测MSPN是否含浸润成分的AUC大于Cdmax/Td,差异有统计学意义(0.914比0.855,Z=2.243,P<0.05)。单因素分析结果表明CTC与肺腺癌LDCT肿瘤最大径(Td)、病理分期、淋巴结转移明显相关(χ²=7.118、14.474、4.368,P<0.05),与恶性结节脉管侵犯、胸膜侵犯、表皮生长因子受体(EGFR)突变无相关(χ²=1.601、0.822、0.457,P>0.05)。结论CTC对MSPN病理浸润具有预测价值;CTC联合LDCT对MSPN病理浸润的预测价值优于单纯影像预测;CTC与Td、淋巴结转移、术后TNM分期呈正相关。     

105例卵巢肿瘤术中冰冻切片的病理诊断与分析

目的总结探讨卵巢肿瘤冰冻切片病理诊断价值。方法对105例卵巢手术患者均行术中冰冻切片、术后石蜡切片病理检查,比较两组病理诊断结果。结果冰冻切片病理检查结果与石蜡切片病理检查诊断完全符合率为86.67%(91/100),基本符合率为5.71%(6/105),不符合率为7.62%(8/105)。切片组织学检查诊断符合率结果:性索间质(100.00%),体腔上皮(90.24%),生殖细胞(81.58%),其他来源(100.00%)。良恶性肿瘤诊断符合率:良性肿瘤(97.37%)、恶性肿瘤(90.00%)、交界性肿瘤(88.89%)。结论卵巢肿瘤术中进行冰冻切片病理诊断准确率高,肿瘤良恶性质判断所需时间短,可为手术治疗提供客观依据。     

胸腔镜手术在孤立性肺结节诊断和治疗中的应用

目的探讨胸腔镜手术在孤立性肺结节诊断和治疗中的价值。方法1994年5月～2009年11月,经胸片、胸部CT发现的周围型孤立性肺结节(直径≤3cm)115例,术前均无明确病理诊断,经胸腔镜手术局部切除,术中送快速冰冻病理检查,根据病理结果和病人情况决定手术方式。原发性肺癌行全胸腔镜或胸腔镜辅助小切口肺叶切除、淋巴结清扫40例;行肺楔形切除75例,其中良性肿瘤59例、转移癌11例、不适合肺叶切除的原发性肺癌5例。结果所有病人均明确病理诊断,确诊率100%。术中、术后并发症10例(8.7%,10/115):全胸腔镜肺叶切除术中肺动脉分支出血1例,转小切口开胸止血;胸引管拔除超过1周3例,呼吸功能不全3例,肺不张、胸腔积液、切口感染各1例,经对症治疗治愈。无严重手术并发症,无手术死亡。良性肿瘤59例随访2～176个月,平均44.5月,无复发。原发性肺癌行全胸腔镜肺叶切除、淋巴结清扫18例,随访3～24个月,平均11个月,1例24个月复发仍存活,其余无复发。结论胸腔镜手术在明确孤立性肺结节病理诊断方面有不可取代的重要作用。良性孤立性肺结节得到治愈,原发肺癌可以得到明确诊断,及时有效的治疗,微创效果显著。     

电视胸腔镜手术前SPECT/CT引导Sens-cure针穿刺定位肺小结节

目的观察电视胸腔镜手术(VATS)前SPECT/CT引导Sens-cure针穿刺定位肺小结节(直径≤10 mm)的价值。方法对19例肺小结节患者行SPECT/CT引导下经皮穿刺定位,共定位21个肺小结节;之后行VATS,根据定位器位置寻找靶病灶,并予以局部楔形切除。观察定位成功率、穿刺定位时间、肺结节大小、胸膜下距离、并发症及病理类型等。结果经皮穿刺定位肺小结节成功率100%,平均定位时间(15.0±3.1)min;病灶最大径(7.1±1.8)mm,胸膜下距离(17.8±5.8)mm;而后均成功完成VATS,完整切除靶病灶,无脱靶。术后病理诊断其中16个(16/21,76.19%)为病变恶性。穿刺后并发症包括少量出血2例、少量气胸3例。结论VATS术前SPECT/CT引导Sens-cure针穿刺定位肺小结节安全有效,可提高VATS成功率。     

Evaluation of the new IASLC/ATS/ERS proposed classification of adenocarcinoma based on lepidic pattern in patients with pathological stage IA pulmonary adenocarcinoma

Background

The International association for the study of cancer (IASLC)/American thoracic society (ATS)/European respiratory society (ERS) has established a new subclassification of lung adenocarcinoma, especially for the lepidic pattern component, formerly called bronchioloalveolar adenocarcinoma (BAC). According to the new classification, BAC has been classified into the following 4 main subtypes: adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IA), and variants of invasive adenocarcinoma (VIA). An observational study was conducted to validate this classification in patients with pathological stage IA pulmonary adenocarcinoma.

Patients and methods

147 patients treated for pathological stage IA lung adenocarcinoma by complete resection at Osaka University Medical Hospital from January 1993 to December 2002 were assessed. The tumor specimens of the cohort were classified into the 4 subgroups. In addition, these groups were compared for various prognostic factors.

Results

Adenocarcinoma in situ was observed in 30 patients, MIA in 8, IA in 104, and VIA in 5 patients, with 5-year survival rates of 100, 100, 85.5, and 60.0 %, respectively. The relationship between the histological classification and K-ras mutation was significant (p < 0.001), especially when comparing the VIA group with the others (p ? 0.001). Ki67-labeling indices were significantly different between the AIS and IA groups (p = 0.040).

Conclusions

This study validated the proposed IASLC/ATS/ERS classification for pulmonary adenocarcinoma in patients with pathological stage IA pulmonary adenocarcinoma. The difference between AIS and IA may depend on the proliferation of the carcinoma. In addition, the difference between VIA and the other adenocarcinoma types may depend on genetic factors, especially K-ras mutations.     

Computed tomography versus frozen sections for distinguishing lung adenocarcinoma: A cohort study of concordance rate

BackgroundComputed tomography (CT) imaging can help to predict the pathological invasiveness of early-stage lung adenocarcinoma and guide surgical resection. This retrospective study investigated whether CT imaging could distinguish pre-invasive lung adenocarcinoma from IAC. It also compared final pathology prediction accuracy between CT imaging and intraoperative frozen section analysis.MethodsThis study included 2093 patients with early-stage peripheral lung adenocarcinoma who underwent CT imaging and intraoperative frozen section analysis between March 2013 and November 2014. Nodules were classified as ground-glass (GGNs), part-solid (PSNs), and solid nodules according to CT findings; they were classified as pre-IAC and IAC according to final pathology. Univariate, multivariate, and receiver operating characteristic (ROC) curve analyses were performed to evaluate whether CT imaging could distinguish pre-IAC from IAC. The concordance rates of CT imaging and intraoperative frozen section analyses with final pathology were also compared to determine their accuracies.ResultsMultivariate analysis identified tumor size as an independent distinguishing factor. ROC curve analyses showed that the optimal cut-off sizes for distinguishing pre-IAC from IAC for GGNs, PSNs, and solid nodules were 10.79, 11.48, and 11.45 mm, respectively. The concordance rate of CT imaging with final pathology was significantly greater than the concordance rate of intraoperative frozen section analysis with final pathology (P = 0.041).ConclusionCT imaging could distinguish pre-IAC from IAC in patients with early-stage lung adenocarcinoma. Because of its accuracy in predicting final pathology, CT imaging could contribute to decisions associated with surgical extent. Multicenter standardized trials are needed to confirm the findings in this study.     

Significance of a single pulmonary nodule in patients with previous history of malignancy

Objectives: To determine the diagnosis, treatment and follow-up in patients with a solitary lung nodule and a previous primary extrapulmonary neoplasm. Methods: The authors evaluated the charts of 45 patients with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule. The histologic characteristics of the nodule were correlated with those of the extrapulmonary neoplasm. Results: The histology of the nodule was not known preoperatively in 43 cases (93.5%); in the remaining three cases cytologic examination had shown the presence of atypical cells. The majority of pulmonary lesions (73.9%) were found during the follow-up of the previous tumour, but a significant percentage of nodules (17.4%) were found incidentally. Pre- or intraoperative localisation of the nodule was done in 19 cases (41.3%), and was successful in nine cases (47.4%). Thoracoscopy was performed in 44 patients (95.6%). The coincidence between the pathology of the previous tumour and that of the nodule was 41.3% (19/46). The coincidence rate was 100% for the tumours of ovary, prostate, and sarcomas. Conclusions: The advent of minimally invasive surgical techniques has made a definitive diagnosis likely, providing also therapy with a less painful engagement for the patient and a less cost for the community.     

术中标本摄片用于乳腺可疑钙化病变组织活检

目的 观察术中标本摄片用于乳腺可疑钙化病变组织活检的价值。方法 对48例乳腺单发可疑钙化病变患者行X线三维立体定位引导活检术,对其中12例行核芯针穿刺活检(SCNB)、22例行真空辅助旋切活检(SVAB)、14例行导丝定位手术切检(SNLB),术中以标本摄影系统对组织标本行X线摄片,之后对标本中的钙化进行标记并送病理检查;评估标本摄片在3种活检方式中显示钙化的清晰度及组织学低估情况,观察SNLB术中标本摄片所示钙化数目及切缘状态,并与术前乳腺X线片进行比较。结果 所有标本均获得目标钙化组织。术中标本摄片显示钙化清晰度优于术前乳腺X线片,显示SNLB组织内钙化数量多于术前乳腺X线片。14例SNLB中,12个术中标本摄片显示切缘阴性,与术后病理结果一致;2个切缘阳性,且钙化呈多灶性分布,术中快速冰冻切片结果均为恶性并切缘阳性,手术计划由保乳手术改为乳腺癌改良根治术。SCNB、SVAB活检结果及SNLB术中冰冻切片结果与手术病理结果均一致。结论 术中标本摄片用于乳腺可疑钙化病变组织活检具有一定价值。     

全胸腔镜手术在肺部局灶性磨玻璃影结节诊疗中的应用

目的探讨全胸腔镜手术在局灶性磨玻璃影(focal ground-glass opacity,fGGO)诊断与治疗中的价值。方法2007年5月～2011年5月对46例术前未确诊的fGGO行全胸腔镜手术。病变位于外周,先完成VATS下的楔形切除,在术中冰冻的基础上行解剖性肺叶切除及系统性淋巴结清扫。若病变靠近肺门,不易行楔形切除,则直接行肺叶切除,根据术中冰冻结果是否行淋巴结清扫。结果 46例均顺利完成手术,手术时间98～117 min,平均107.5 min;术后住院时间3～5 d;切口总长度5～6 cm,术后疼痛轻;术后自控镇痛1～2.5 d(平均1.5 d)。术后病理良性8例:结核球6例,真菌病2例。恶性肿瘤38例:其中3例为PET/CT诊为良性;支气管肺泡癌14例,腺癌11例,含有支气管肺泡癌成分的腺癌11例,大细胞肺癌2例。fGGO恶性率为82.6%(38/46),其中支气管肺泡癌比例最高,为36.8%(14/38)。术后并发症3例(6.5%,3/46):2例肺不张,经对症治疗治愈;1例胸腔持续漏气11 d,自愈。术中确诊的38例行淋巴结清扫,共切除淋巴结394枚(每例9～15枚,平均12枚/例),淋巴结转移7枚,全部为N1淋巴结。结论全胸腔镜手术治疗fGGO安全、有效。     

Limitations of Ampullectomy in the Treatment of Nonfamilial Ampullary Neoplasms

Background Pancreaticoduodenectomy (PD) is the standard surgical management of invasive ampullary neoplasms. A rational plan to use ampullectomy (AMP) for lesions at this location requires careful analysis of preoperative clinical information (comorbidity, lesion size, and histopathology) and intraoperative data (frozen section pathology and clinical impression) to properly select patients for this treatment. Methods We identified 140 consecutive cases of nonfamilial ampullary neoplasms from our prospective institutional database over a 7-year period (1996–2003). Preoperative and intraoperative factors were analyzed and related to outcomes. Results AMP was planned for 37 patients with small lesions (median, 1.86 cm [range, 0–3 cm] vs. 2.6 cm [range, 0–8 cm] in PD). AMP was converted to PD because of the extent of disease in three and an intraoperative diagnosis of invasive cancer in five patients. Preoperative biopsy had a diagnostic accuracy of 79% (97 of 123) but missed 23 cancers. Intraoperative frozen section had a diagnostic accuracy of 84%; two cases of high-grade dysplasia and invasive cancer were missed. Patients with invasive cancer treated by AMP had a decreased recurrence-free and disease-specific survival compared with those treated by PD. Lymphatic spread of disease was associated with diminished long-term survival. Although both vascular invasion and tumor stage independently predicted lymphatic metastases, both were limited by their sensitivity. Conclusions The reduced morbidity and mortality of AMP makes this the preferred treatment for benign lesions of the ampulla. Conversion to PD should be considered when intraoperative or final pathology identifies invasive adenocarcinoma. Refinement of clinicopathologic factors may reduce the occasional PD for benign disease and AMP for malignancy. Presented at the 58th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, Georgia, May 3–6, 2005.     

Transduodenal Resection of Peri-Ampullary Lesions

Transduodenal resection (TDR) of lesions near the ampulla of Vater is an alternative to the Whipple pancreaticoduodenectomy. A retrospective analysis was performed to determine the long-term outcome and the utility of intraoperative frozen section examinations in aiding operative decision making in patients undergoing TDR. From 1992 to 2002, 19 patients with an average age of 64.2 years (range: 33–84 years) underwent a transduodenal resection of a peri-ampullary lesion; median follow-up was 47 months (range: 2–100 months). Pathology of the lesions was as follows: 11 with benign ampullary adenomas, including 4 with familial adenomatous polyposis (FAP); 7 with peri-ampullary adenocarcinomas; and 1 with a benign stricture. Survival for the entire cohort is 100%. In 12 cases an intraoperative frozen section was performed. The specificity and positive predictive value of the intraoperative histology were both 100%, and the sensitivity and negative predictive value were 57% and 38%, respectively. Three of the 4 patients with FAP have recurrent adenomatous change; 2 of the 7 with carcinoma have metastatic adenocarcinoma. Transduodenal resection of peri-ampullary lesions appears to be a safe alternative to radical resection for benign adenomas and selected carcinoma. Intraoperative frozen section assessment is recommended in cases of potential adenocarcinoma.Oral presentation at AHPBA meeting, Miami, Florida, USA, 2003.     

色素痣样皮损381例的临床与组织病理分析

目的:探讨381例色素痣样皮损的临床与病理之间的关系。方法:对381例色素痣样的病例做临床及组织病理诊断回顾性分析。结果:381例色素痣样皮损中,病理诊断符合色素痣327例,符合率为93.7%,组织病理类型:皮内痣219例(67%),混合痣89例(27.2%),交界痣8例(2.4%)及其他11例(3.4%);327例色素痣中,先天性色痣140例(42.8%),组织病理类型:皮内痣74例(52.9%),混合痣55例(39.3%),交界痣7例(5%)及蓝痣4例(2.8%);临床误诊为色素痣54例,病理诊断居前5位为脂溢性角化病、血管角皮瘤、基底细胞癌、黑素瘤、鳞状细胞癌。结论:色素痣样皮损的正确诊断需要结合组织病理分析。     

肺部微小结节的微创伤诊治

目的 确定肺部微小病灶的微创诊治方法。方法 对ＣＴ和Ｘ线胸片发现肺部病灶在１．３ｃｍ以下的２６例病人,利用胸部微创伤外科技术将之楔形切出,肿物完整送作快速连续多层病理冲冻切片以确诊,恶性者作进一步肺叶切除加淋巴清扫。淋巴结各组病理切片均未发现转移。术后１４例未作化疗和疗效,５例化疗１～２疗程。结果 １９例最后诊断为恶性,占７３％,全部为Ⅰ期;６例为良性,占２７％。术后病理诊断与术前ＣＴ定性诊断相符